Empirical management of community-acquired pneumonia: impact of concurrent A/H1N1 influenza pandemic on guideline implementation.

BACKGROUND: Guideline-concordant therapies have been proven to be associated with improved health and economic outcomes in the treatment of community-acquired pneumonia (CAP). However, actual use of CAP guidelines remains poor, but using tailored interventions looks promising. Based on local observations, we assessed the impact of low-intensity interventions to improve guideline use. METHODS: Pre-and post-intervention study with segmented regression analysis in a large tertiary care centre [University Hospitals Leuven (UZL)] and a smaller secondary care control hospital [Ziekenhuis Oost-Limburg (ZOL)] from October 2007 through to June 2010 in Belgium. RESULTS: A total of 477 patients were included in UZL, with 58.5% of the patients treated according to local guidelines. Guideline adherence remained stable, but a decrease (-28.6%; P = 0.021) was observed during guideline re-introduction in October 2009. Further analysis showed a high correlation with the concurrent A/H1N1 influenza pandemic (r(point-biserial) = 0.683; P = 0.045) and with suspected influenza infection (odds ratio = 2.70; P = 0.038). In ZOL, 326 patients were enrolled, with 69.3% being treated concordantly. A similar, non-significant decrease in guideline adherence was observed after October 2009. CONCLUSIONS: Our interventions did not lead to a higher proportion of CAP patients receiving guideline-compliant therapy. Instead, a compliance decrease was observed, coinciding with the peak in the A/H1N1 pandemic in the population. Similar observations could be made in ZOL. The widespread attention for this pandemic may have altered the perception of needed antibiotic therapy for pulmonary infections, bypassing our interventions and decreasing actual guideline compliance. Increased vigilance and follow-up is needed when epidemics with similar impact occur in the future.

Combining road safety information in a performance index.

In this paper we focus on an essential step in the construction process of a composite road safety performance indicator: the assignment of weights to the individual indicators. In the composite indicator literature, this subject has been discussed for a long time, and no agreement has been reached so far. The aim of this research is to provide insights in the most important weighting methods: factor analysis, analytic hierarchy process, budget allocation, data envelopment analysis and equal weighting. We will give the essential theoretical considerations, apply the methods on road safety data from various countries and discuss their advantages and disadvantages. This will facilitate the selection of a justifiable method. It is shown that the position of a country in the ranking is influenced by the method used. The weighting methods agree more for countries with a relatively bad road safety performance. Of the five techniques, the weights based on data envelopment analysis resulted in the highest correlation with the road safety ranking of 21 European countries based on the number of traffic fatalities per million inhabitants. This method is valuable for the development of a road safety index.